When my team and I set out to solve a problem through wearable technology, we utilize an approach called Design Thinking. I’ve written about Design Thinking and how it works before, but to truly understand the value of this process it’s critical to talk about each step, in greater detail.
This is part 1 of a 6-part series where we’ll dive into each step of the process and I’ll share some insight into the techniques we use, and challenges associated with our process.
First… a Story
The first project I worked on where I combined my fashion education with medical design was called the PlaySkinLift Project. I was a doctoral student working with a group of engineers led by Dr. Michele Lobo to address a deficit in the existing standard of care for a debilitating condition affecting babies and toddlers.
The condition, which arises for a variety of reasons, renders the child’s arms immobile. The child will display otherwise typical development but will not be able to use their arms. This has serious implications on development as well as quality of life. Eating, getting dressed, playing, and other routine actions are challenging or impossible for children who suffer from this condition and aside from the immediate implications, children who are unable to partake in everyday activities for their age group run the risk of other developmental issues later on.
At the time that my team and I set out to create a solution to this issue, there were a ton of different options to aid users with lower extremity issues – canes, walkers, wheelchairs, advancements in exoskeleton technology – but very few addressing limited arm function. The only solution that existed, to our knowledge, was very bulky, unattractive, and of limited effectiveness. It essentially propped up the user’s arms to be outstretched in front of them, at about shoulder height. The system allowed only side-to-side movement on that same plane. The kids would jokingly say they looked like zombies.
To top it off, the system was prohibitively expensive. Each arm support was sold separately for around $8,000 and was generally not covered by insurance.
Looking at this situation as it stood, it was a clear opportunity: a significant quality of life issue, current standard of care was extremely limited and expensive, and what solutions did exist only partially addressed the issue and did so in a way that did not encourage end-user compliance.
This problem looked like a natural fit for my new design direction and so, under the supervision of Dr. Lobo, a team of student engineers and I set out to solve it.
We set up in the lab, shut ourselves in, and began to brainstorm and design. We sourced materials from wherever made sense, in this case, Target, and started to construct a prototype. Using spandex, wires, Velcro, and about 30 fasteners we created a bodysuit, sized for an infant.
And the bodysuit worked! We tried it on a baby and the baby could move his arms and we were thrilled at our success. I spoke to the baby’s mother and was expecting her to be overjoyed. Instead, she said, “You know, this is great that he can move his arms but it’s really hard for me to put it on him. It’s difficult to wash, it’s hot for him, and honestly, it’s weird to see a baby in a full-body unitard.”
This was a pivotal moment for me in my career and the way I approached my work. The team and I did great work – we created a successful solution. But we did it in a vacuum, we didn’t completely consider whose needs had to be met, only the symptoms we had identified. Is the user able to move his arms? Yes! Is it comfortable? More than before. Is it visually appealing? No. Is it easy to use and care for? No.
The PlayskinLift project was, by and large, a success, and my experience completing it helped me see the promise in this work and what could be achieved through wearable technology. But more than that, I learned an invaluable lesson from this project: if you don’t start from a place of empathy you cannot create a solution that truly addresses the needs of your end-user and your stakeholders.
Committing fully to approaching every project from a place of empathy, these days nearly all of my projects begin with a survey. I use surveys even if I have worked with the patient group in the past because the most critical point to start with is putting aside your assumptions. By using surveys, I can get a sense of the landscape I’m working in without engaging with my own biases. My subjects speak for themselves in their own words about their issues, helping me move forward based on their concerns, not mine.
Quickly after surveying, I try to have face-to-face conversations with my subjects. The surveys are good to get started but the real information that you need, the real understanding, comes from getting end-users talking.
There are two points to keep in mind which can significantly impact the outcome of an interview:
a. Location – where the interview is conducted.
b. The way your questions are asked – this is a little more difficult to quantify.
Location is an often overlooked but very important factor when trying to get a sense of a person’s day-to-day life and challenges. Often the most convenient or most natural location would be the office or lab of the designer. After all, in a professional office, it is routine to have meetings and host visitors.
While convenient, having interviews where the interviewee is out of their element means you are imposing upon the subject. It formalizes the process and can cause the subject to have preconceived notions as to how the interview will work, making them uncomfortable.
We seek to create technology that integrates into peoples’ lives and routines and so we should try as best we can to integrate into their lives as well. Whenever possible, meeting someone in their homes, at their places of work (if appropriate), schools, daycare centers, or wherever a subject is in a typical day, will give you a much fuller picture, as well as greater buy-in, from those you are seeking to help.
Asking the Right Questions
Beyond location, it is vital to carefully consider the questions you ask and the way you ask them. This is more difficult to get right than location but equally, if not more, important.
When interviewing people, I am always trying to avoid creating a ‘good subject’, but it’s easy to fall into that trap. For instance, let’s say I am speaking to someone with a physical disability and I ask them, “What are your typical challenges with getting dressed on a daily basis?”
What I’m hoping is to gain real insight into the subject’s routine and difficulties, but what I’m inadvertently prompting is a formal, sterile answer because I’ve asked a formal, sterile question. Speaking with your subject in a way that people don’t normally speak to each other encourages your subject to tell you the kinds of things they would think you’d want to hear. This creates a ‘good subject’ and really hinders your ability to understand their lives.
Creating a dialogue with people, talking to them about their days and their lives, rather than putting them on the spot with uncomfortable questioning, allows you to get a richer understanding of the specifics of their obstacles and where you can help. This approach not only is empathetic, but it also communicates empathy, which in turn cultivates trust, allowing you to glean critical information.
Getting to know people by understanding who they are, where they come from, and what their needs are, enables me to not only address those needs but to ensure that my solution is functionally practical, meaning that it actually fits into their lives.
No methodology is without challenges, no matter how thorough. Every new project we begin comes with its own individual hurdles, but there are a few that are usually present.
Knowing the different stakeholders and understanding their roles can prove to be challenging and can make design challenging. In the PlayskinLift Project, our end-user was a baby or a toddler. We can speak with children and learn a huge amount from what they say and from body language, but there are limitations. In many cases with children, people who have more severe mental disabilities, and those with other conditions which affect communication, their needs will be at least in part communicated by a caregiver. The needs of the caregiver themselves need to be taken into account as well because they have a significant role to play in user compliance. These perspectives will be different, but each needs to be approached from a position of empathy and understanding.
In some cases neither an end-user nor a caregiver are the purchaser – no matter how great or useful the design is, no matter how thrilled the end-user and caregiver may be, if your design is rejected by the purchaser you won’t be able to help anyone. Considering their perspective as you design can make or break the success of your project.
Another obstacle, which all of my work is designed to help overcome, is that the medical device industry, in general, considers an empathetic approach as a radical notion. Often patients are split into ‘compliant patients’ and ‘non-compliant patients’, as though some people are willing to accept care and some aren’t. The reality is that if a device or product is not accepted by the user base it is not due to flaws in the user base, it is due to flaws in the design. Trying to understand why a patient does not accept care helps to lead me to the alterations and design enhancements that enable user compliance.
Putting aside assumptions, biases, and expectations is the only way to understand a patient population and design products which fit into their lives, rather than trying to fit them into your product.
An empathetic approach is the first step of every project, but it also defines the steps that follow. It is the cornerstone of successful design and something that my team and I keep on our minds at all times throughout a project.
I hope you’ve enjoyed reading this deep dive into the empathetic approach. Stay tuned for the next blog in this 6-piece series, Defining the Problem!